摘要
贴横结肠切断大网膜,依次于根部离断网膜左血管、网膜右静脉及网膜右动脉,完成No.4sb和6组淋巴结的清扫。于脾动脉根部进入胰腺上缘,依次清扫No.11p、9、7、8a、12a及5组淋巴结。离断十二指肠,清扫No.12a、11d及10组淋巴结。用无菌麻绳对食管下段进行结扎,在食管“自牵引”的状态下完成下纵隔的游离并于结扎线近端食管右后壁打孔,取Treitz韧带远端约25 cm处小肠,游离系膜后对系膜缘肠壁打孔。行食管右后壁与空肠对系膜缘的侧侧吻合。通过助手主操作孔在切除共同开口的同时切断食管和空肠完成后离断食管空肠吻合。然后留置45 cm无功能袢做空肠-空肠侧-侧吻合。
After the separating the greater omentum and the left gastroepiploic vessel,the right gastroepiploic vein and artery were ligated in order to dissect lymph nodes(LNs)No.4sb and No.6.Dissection of suprapancreatic area LNs was started from the root of splenic artery.LNs No.11p,9,7,8a,12a and 5 were dissected in sequence.Duodenum was transected followed by dissection of LNs No.12a,11d and 10.A sterile hemp rope was held to ligate and drag down the esophagus to maintain'self-pulling'environment,allowing the detachment of the posterior mediastinum.Then a hole was made on the right-posterior wall of the esophagus above the ligature rope.After mobilizing the mesentery,the small intestine was made at the anti-mesenteric border of the jejunum 25 cm distal to the ligament of Treitz.A side-to-side esophagojejunostomy(E-J)was then performed between the right-posterior wall of esophagus and the anti-mesenteric wall of the jejunum to form an entry hole.The'latter transection'applied with the stapler inserted from the trocar of assistant's main operating holeand therefore enabled the esophagus and the proximal jejunum to be simultaneously transected above the level of the entry hole.After that,a side-to-side jejunojejunostomy(J-J)was carried out between the afferent loop stump and the roux limb 45 cm below E-J.
作者
蒿汉坤
洪军
Hao Hankun;Hong Jun(HuashanHospital,FudanUniversity,200040)
出处
《中华普外科手术学杂志（电子版）》
2020年第6期556-556,共1页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
关键词
胃肿瘤
腹腔镜
胃切除术
Stomach neoplasms
Laparoscopes
Gastrectomy
作者简介
通信作者:蒿汉坤,Email:haohankun@163.com,现任复旦大学附属华山医院,外科学博士,副主任医师,副教授,哈佛医学院临床科研培训项目学者,兼任中国抗癌协会胃癌专业委员会微创外科学组委员,中国临床肿瘤学会(CSCO)肿瘤微创外科专家委员会委员,中国医师协会微创外科专业委员会青年委员,中国抗癌协会大肠癌专业委员会青年委员,上海市抗癌协会微创专业委员会腔镜学组委员,上海市抗癌协会胃肠肿瘤腹腔镜专业委员会委员,美国Cleveland Clinic结直肠中心访问学者,2018、2019连续两届中国中青年医师胃癌手术视频大赛冠军,首创全腔镜下近端胃切除双通道三角吻合重建及腹腔镜全胃切除术自牵引后离断(SPLT)食管空肠腹腔镜下吻合重建。
